Perioperative and continence outcomes of robotic radical prostatectomy in elderly Indian men (≥70 years): A sub-group analysis.

INTRODUCTION: Many healthy elderly Indian men seek surgical treatment for localized prostate cancer. Quite often, radical surgery is not offered to the patients over 70 years of age due to the perception of increased side-effects and complications. We have previously reported our results of robotic radical prostatectomy in a study comprising 150 Indian patients, where almost a quarter of patients were elderly. This subgroup analysis was therefore focused on evaluating perioperative and continence outcomes in elderly men (≥70 years) with localized prostate cancer. MATERIALS AND METHODS: Between April 2010 and August 2013, 153 men had robot-assisted radical prostatectomy performed by two surgeons. Of the 150 men analyzed, 39 (26%) were aged ≥70 years. All patients underwent robotic prostatectomy using a 4 arm da Vinci surgical system. Pre-operative, intraoperative and post-operative parameters were studied. Check cystogram was performed in all patients prior to catheter removal. Complications were categorized using the Clavien-Dindo classification system. Continence was defined as use of "no pad" or security liner only. All data were recorded prospectively and analyzed using SPSS version 20. RESULTS: There were no significant intraoperative or perioperative complications in this group. Median blood loss during surgery was 150 mL. None of the patient required blood transfusion. There were two minor complications (5.1%) within the first 30 days of surgery: Minimal anastomotic site leak (one patient) requiring replacement and prolongation of Foley's drainage by 1 week and ileus (one patient). No patient had any cardiopulmonary or vascular complications in the post-operative period. The median duration of hospital stay was 3 days. The median duration of catheterization was 7 days. No patient had problem of bladder neck stenosis in the follow-up period. At 1 month, 3 months, 6 months and 1 year of follow-up, 66.7% (n = 26), 74.3% (n = 29), 87.9% (n = 34) and 94.8% (n = 37), respectively, were continent. CONCLUSIONS: Robotic surgery is safe and feasible in a select group of elderly patients. It has acceptable and minimal perioperative complications along with good continence outcome.

Continence outcomes following robotic radical prostatectomy: Our experience from 150 consecutive patients.

INTRODUCTION: Urinary continence is an important outcome parameter after robot assisted radical prostatectomy (RARP). We evaluated the continence outcomes following RARP using a double-layered urethrovesical reconstruction. MATERIALS AND METHODS: One hundred fifty consecutive patients undergoing RARP and double-layered urethrovesical reconstruction were prospectively studied for preoperative, intraoperative and post operative parameters. Key points followed during surgery were: Minimal dissection of sphincteric complex, preservation of puboprostatic ligament, selective ligation of deep venous complex and both posterior and anterior reconstruction using the Von Velthoven stitch. Intraoperative bladder fill test was done at the end of anastomosis to rule out urine leak. Check cystogram was done prior to catheter removal in the outpatient department. Patients were subsequently followed at regular intervals regarding the status of urinary continence. All patients irrespective of adjuvant therapy were included in the analysis. RESULTS: The mean age was 64 years (standard deviation ± 6.88), and mean serum PSA was 20.2 ng/ml. The mean BMI was 25.6 (SD: ±3.84). The mean prostate weight was 44.09 gm (range 18-103 gm, SD: ±15.59). Median days to catheter removal after surgery was 7 (range 4-14 days) days. Cystographically determined urinary leaks were seen in two patients. Urine leak was managed by delaying catheter removal for 1 week. Minimum 6 month follow up was available in 126 patients. 'No pad' status at 1 week, 1 month, 3 months, 6 months and 1 year was 15.1%, 54.9%, 78%, 90.5% and 94.1%, respectively. CONCLUSION: Excellent continence outcomes are observed in patients undergoing double-layered urethrovesical reconstruction.

Axillary breast cancer in a Nigerian woman.

Ectopic breast cancer is rare and diagnosis is commonly delayed. We report the case of a 34-year-old Nigerian woman with a locally advanced invasive ductal carcinoma in the axillary breast. She underwent an axillary mastectomy and is due to receive adjuvant chemotherapy and radiotherapy. The management of this patient is discussed in relation to existing medical literature on the subject.

Giant hydrocele--an epitome of neglect.

Hydrocele [Greek: water--sac] is abnormal fluid collection within the tunica vaginalis of the scrotum or a patent tunica vaginalis. It is a relatively common condition in surgical practice. However, a giant hydrocele, here defined for clinical purposes, as a hydrocele equal to or bigger than the patient's head, is rare as indicated by the limited number of reported cases in the literature. In this paper I am presenting three cases of giant hydroceles and highlighting how it affects the quality of patients' life by way of complications, infertility, sexual function and work capacity.